NPIMap

Individual provider Active NPI

Irene Dmitruk, DO

  • Emergency Medicine Physician
  • Saint John, IN
National Provider Identifier
1861703399
Registry record updated Dec 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
02003817A Issued in IL
Practice address
9660 Wicker Ave
Saint John, IN 46373-9487
Phone
(219) 365-1177
Fax
(219) 703-6662
NPI assigned
Jun 30, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 21, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 11014502A IN
Emergency Medicine Physician 207P00000X 02003817A IL Primary

Addresses

Primary practice location

9660 Wicker Ave
Saint John, IN 46373-9487

Mailing address

8558 Broadway
Merrillville, IN 46410-7032
Phone (201) 961-2477

Other practice location 1

1632 S Indiana Ave
#307
Chicago, IL 60616-1387
Phone (201) 961-2477

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111109000343 IN Practitioner - Emergency Medicine 5597938423 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Philadelphia College of Osteopathic Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cep America LLC 995 clinicians

Practice addresses (Care Compare)

1500 S Lake Park Ave
Hobart, IN 46342-6638
Phone (219) 942-0551

Hospital & facility affiliations

  • St Mary Medical Center Inc Hospital, Hobart, IN, CCN 150034

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
02003817AILMDEmergency Medicine Physician
11014502AINMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America LLC Emergency Medicine CurrentSince Feb 1, 2022 Accepting new patients
Cep America LLC Emergency Medicine CurrentSince Feb 1, 2022 Accepting new patients
Cep America LLC Emergency Medicine Current Accepting new patients
Lafayette Emergency Care, P.C. Emergency Medicine Past Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

4321 Fir St
East Chicago, IN 46312
Phone (219) 392-1700

1500 S Lake Park Ave
Hobart, IN 46342
Phone (219) 942-0551

1606 N 7th St
Terre Haute, IN 47804
Phone (812) 238-7523

Organizations & group practices 22

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 22

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1277856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608508800000",
    "number": "1861703399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8558 BROADWAY",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464107032",
            "telephone_number": "201-961-2477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9660 WICKER AVE",
            "city": "SAINT JOHN",
            "state": "IN",
            "postal_code": "463739487",
            "telephone_number": "219-365-1177",
            "fax_number": "219-703-6662"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1632 S Indiana Ave",
            "address_2": "#307",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606161387",
            "country_code": "US",
            "telephone_number": "201-961-2477",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DMITRUK",
        "first_name": "IRENE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-06-30",
        "last_updated": "2020-12-21",
        "certification_date": "2020-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "11014502A",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "02003817A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint John, IN

Sources for this page

Verify at the official NPI Registry.